Provider Demographics
NPI:1619058500
Name:SAVIOR'S GRACE HOME CARE, LLC
Entity Type:Organization
Organization Name:SAVIOR'S GRACE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:CORBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-652-3470
Mailing Address - Street 1:9710 JUNCTION RD STE A
Mailing Address - Street 2:ATTN: LYNN MAURER
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-9502
Mailing Address - Country:US
Mailing Address - Phone:989-652-4663
Mailing Address - Fax:989-652-4790
Practice Address - Street 1:28910 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2337
Practice Address - Country:US
Practice Address - Phone:734-425-0541
Practice Address - Fax:734-425-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOE177OtherBCBS PROVIDER #
MI4410947Medicaid
MI4410947Medicaid